POS0698 CHANGES IN RA PATIENT PROFILE AT INITIATION OF FIRST TARGETED THERAPY OVER A FIVE-YEAR PERIOD: ANALYSIS OF THE STRATEGE 1 AND STRATEGE 2 STUDIES.
Authors: C. Gaujoux-Viala, E. Dernis, E. Senbel, H. Herman-Demars, A. Courbeyrette, R. M. Flipo
Journal: Annals of the Rheumatic Diseases (2022)

Background The objective of the STRATEGE2 study (inclusion period: Feb. 2019-Dec. 2020) is to describe the therapeutic strategy in rheumatoid arthritis (RA) patients treated with methotrexate (MTX) for at least 3 months, not having received targeted biological (bDMARD) or synthetic (tsDMARD) therapy and who are candidates for initiation of first b/tsDMARD therapy due to RA activity. The STRATEGE1 study [1] (conducted between 2014 and 2015) described the therapeutic strategies introduced for RA patients with an inadequate response to MTX monotherapy. Objectives We aim to compare the profiles of patients included in these two studies at first prescription of b/tsDMARD therapy, in order to evaluate changes in rheumatologist practices over this five-year period. Methods STRATEGE1 and 2 are two French multicentre, prospective, longitudinal, observational studies including patients with confirmed RA (ACR 1987 or ACR/EULAR 2010). Our aim is to compare baseline data. Only data from the sub-group of patients initiating b/tsDMARD therapy are presented for STRATEGE1. Qualitative variables are compared by Fisher’s exact test and quantitative variables by t-test. Results In STRATEGE1 (2014-2015), 117 out of 854 patients initiated a b/tsDMARD therapy. In STRATEGE2 (2019-2020), 230 patients were included, with 180 in the analysis population. Table 1. At baseline (before b/tsDMARD initiation) STRATEGE1 (N=117) STRATEGE2 (N=180) p Mean age (years) 52.6 ±12.5 56.4 ±13.6 0.0158 RA duration (years) 6.5 ±7.1 5.6 ±7.2 NS Radiological signs 50.0% 48.0% NS Average MTX initiation (years) 4.6 ±4.3 4.3 ±5.3 NS MTX per os 44.0% 28.9% 0.0088 → mean dosage (mg/week) 16.2 ±3.6 16.0 ±4.1 NS MTX subcutaneous 52.6% 70.6% 0.003 → mean dosage (mg/week) 18.5 ±3.2 19.9 ±3.9 NS → Patients self-administration 53.8% 75.8% 0.0001 Corticosteroid therapy 53% 50.6% NS → mean dosage (mg/day) 8.1 ±4.1 9.5 ±5.8 NS Mean DAS28 4.6 ± .1 4.3 ±1.2 0.0074 Mean HAQ 1.4 ±0.9 1.0 ±0.7 &lt;0.0001 The baseline visits involved initiation of b/tsDMARD therapy with 100% vs. 88.9% bDMARD (anti-TNF: 78.8% vs. 58.3%; anti-IL6: 6.7% vs. 12.8%; CTLA4 Ig: 11.5% vs. 16.7%; anti-CD20: 2.9% vs. 1.1%) and 0% vs . 11.1% tsDMARD. Therapeutic decisions concerning MTX were (STRATEGE 1 vs STRATEGE 2): identical regimen maintained (pharmaceutical form + dosage): 69.2% vs. 76.1%; discontinuation: 4.3% vs. 2.2%; adjustment: 26.7% vs. 21.7% [with dose reduction: 18.2% vs. 93.5% and/or change in pharmaceutical form (p.o. to SC): 54.5% vs. 0%]. Main reasons for adjusting treatment were (STRATEGE 1 vs STRATEGE 2): active RA: 86.1% vs. 77.8%; RA not in remission: 3.5% vs. 21.1%; exacerbation based on clinical/laboratory parameters: 42.6% vs. 10%. Conclusion Over the five-year period, these results suggest a change in practices for RA patients with an inadequate response to MTX and initiating their first targeted therapy: now with earlier recourse to first targeted therapy, for less active RA, and more pronounced investigation of remission. References [1]C. Gaujoux-Viala et al . MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE. Rheumatology 2021;0:1-11. doi:10.1093/rheumatologykeab274. Acknowledgements The authors wish to acknowledge RCTs for their contribution to the statistical analysis, the investigators, centres and patients. Disclosure of Interests Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB., Consultant of: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB., Emmanuelle Dernis Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Eric Senbel Speakers bureau: Abbvie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Consultant of: Abbvie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Hélène Herman-Demars Employee of: Nordic Pharma France, Agnès Courbeyrette Employee of: Nordic Pharma France, René-Marc Flipo Speakers bureau: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi., Consultant of: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi.